EMG biofeedback combined with rehabilitation training may be the best physical therapy for improving upper limb motor function and relieving pain in patients with the post-stroke shoulder-hand syndrome: A Bayesian network meta-analysis

Abstract

BackgroundPost-stroke shoulder-hand syndrome (SHS), although not a life-threatening condition, may be the most distressing and disabling problem for stroke survivors. Thus, it is essential to identify effective treatment strategies. Physical therapy is used as a first-line option for treating SHS; however, it is unclear which treatment option is preferred, which creates confusion in guiding clinical practice. Our study aims to guide clinical treatment by identifying the most effective physical therapy interventions for improving clinical symptoms in patients with post-stroke SHS using Bayesian network meta-analysis.MethodsWe conducted a systematic and comprehensive search of data from randomized controlled trials using physical therapy in patients with SHS from database inception to 1 July 2022. Fugl-Meyer Upper Extremity Motor Function Scale (FMA-UE) and pain visual analog score (VAS) were used as primary and secondary outcome indicators. R (version 4.1.3) and STATA (version 16.0) software were used to analyze the data.ResultsA total of 45 RCTs with 3,379 subjects were included, and the intervention efficacy of 7 physical factor therapies (PFT) combined with rehabilitation training (RT) was explored. Compared with the control group, all the PFT + RT included were of statistical benefit in improving limb motor function and pain relief. Also, our study indicated that EMG biofeedback combined with RT (BFT + RT) [the surface under the cumulative ranking curve (SUCRA) = 96.8%] might be the best choice for patients with post-stroke SHS.ConclusionEMG biofeedback combined with rehabilitation training may be the best physical therapy for improving upper limb motor function and relieving pain in patients with post-stroke SHS according to our Bayesian network meta-analysis results. However, the above conclusions need further analysis and validation by more high-quality RCTs.Systematic review registrationwww.crd.york.ac.uk/prospero/, identifier: CRD42022348743.

Effectiveness of acupuncture for pain relief in shoulder-hand syndrome after stroke: a systematic evaluation and Bayesian network meta-analysis

“…Some studies have reported that the combination of two or more therapies may be more effective than rehabilitation alone. Acupuncture combined with rehabilitation training can significantly help in reducing pain scores, promoting limb motor function recovery, and improving overall effectiveness ( 69–71 , 76 ).…”

Effect of different modalities of artificial intelligence rehabilitation techniques on patients with upper limb dysfunction after stroke—A network meta-analysis of randomized controlled trials

“…The inclusion criteria were as follows: (1) Population: the diagnostic criteria for stroke were met by the Classification of Cerebrovascular Diseases, and a diagnosis of cerebral infarction or cerebral hemorrhage was made by cranial CT or MRI ( 2 , 42 , 43 ). Intervention: six AI technologies (RT, BCI, RR, IR, VR, RT + VR) were used as intervention methods, alone or in combination with artificial intelligence rehabilitation; (3) Comparison: the control group received only conventional rehabilitation or any of the above intervention groups; (4) Outcome: primary outcome: FMA-UE-Total, secondary outcome: FMA-UE-Distal, FMA-UE-Proximal, ARAT and MBI; (5) Study design: only RCTs were included in this study.…”

“…The inclusion criteria were as follows: (1) Population: the diagnostic criteria for stroke were met by the Classification of Cerebrovascular Diseases, and a diagnosis of cerebral infarction or cerebral hemorrhage was made by cranial CT or MRI (2,42,43)…”

Wearable facial electromyography: in the face of new opportunities

“…In conditions such as facial palsy and synkinesis, specific muscle information is required to quantify symptoms' severity [53,54]. Furthermore, a promising technique to expedite rehabilitation of motor palsy is EMG biofeedback, in which the patient learns to control movements by receiving real-time feedback on muscle activation [55][56][57] (in the first case, for example, the muscle synergy was extracted from muscle activity using non-negative matrix factorization). In facial palsy biofeedback, the patient learns to control specific muscle activation ideally without moving the rest of the facial muscles, which requires real-time information in high spatial resolution [58].…”